<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

	    <div class="form-group">
			<label class="control-label col-xs-12 col-sm-2">{:__('卡号前缀')}:</label>
			<div class="col-xs-12 col-sm-8">
				<input id="c-head_number" data-rule="required" class="form-control" name="row[head_number]" type="text" value=""/>
			</div>
		</div>

		<div class="form-group">
			<label class="control-label col-xs-12 col-sm-2">{:__('卡号范围')}:</label>
			<div class="col-xs-12 col-sm-8">
				<div class="col-xs-6 col-sm-6" style="padding-left:0;">
					<input id="c-start_number" data-rule="required" class="form-control" name="row[start_number]" type="number" value="0" placeholder="起始卡号,如:0" onchange="if(parseFloat(this.value)<0 || this.value==='')this.value=0;" onpaste="return false;"/>
				</div>
				<div class="col-xs-6 col-sm-6" style="padding-right:0;">
					<input id="c-end_number" data-rule="required" class="form-control" name="row[end_number]" type="number" value="1" placeholder="终止卡号,如:999" onchange="if(parseFloat(this.value)<0 || this.value==='')this.value=0;" onpaste="return false;"/>
				</div>
			</div>
		</div>


		<div class="form-group">
			<label class="control-label col-xs-12 col-sm-2">{:__('默认余额')}:</label>
			<div class="col-xs-12 col-sm-8">
				<input id="c-balance_money" data-rule="required" class="form-control" name="row[balance_money]" type="number" value="0" onchange="if(parseFloat(this.value)<0 || this.value==='')this.value=0;" onpaste="return false;"/>
			</div>
		</div>

		<div class="form-group layer-footer">
			<label class="control-label col-xs-12 col-sm-2"></label>
			<div class="col-xs-12 col-sm-8">
				<button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
				<button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
			</div>
		</div>
</form>
